February 08, 2011

NY Times Magazine: A Prescription for Fear

Over the past several years, the internet has constantly and consistently changed the face of healthcare, and many would argue, for the better. For example, millions of individuals can now go online to determine whether they have symptoms for chronic diseases or serious problems that require immediate medical attention. Many websites, the majority of which are hosted by professional medical organizations, patient advocacy groups, and the government, provide numerous educational resources to patients about every illness from diabetes to rare orphan diseases.

Despite the wealth of truthful and reliable information these websites provide to millions of Americans, some critics of online health information believe that advice and guidance for individuals about health care from popular websites like WebMD is unethical. As one recent New York Times Magazine article titled A Prescription for Fear asserted, it is “very rare on the medical Web” to get information that does not “peddle drugs” to online users. In fact, the author goes as far as saying that “WebMD is synonymous with Big Pharma Shilling.”

So from what evidence does the author base her claims that sites such as WebMD are peddling drugs, causing hysteria, and offering bad ideas and medicine?

First, the author points to an investigation into WebMD’s relationship with drug maker Eli Lilly started last February by Senator Chuck Grassley (R-IA). The article claims that Senator Grassley’s investigation “confirmed suspicions,” but the author did not explain what those suspicions were, nor did the article indicate what, if any, findings Grassley’s investigation found. Moreover, the author’s suggestion that WebMD is influencing readers and creating some kind of “subtle misinformation due to its connections to pharmaceutical and other companies,” is irresponsible journalism because she uses no evidence to back up her claims. In fact, to date, we are unaware of any findings of wrongdoing or harm to patients from Mr. Grassley’s investigation of WebMD.

Accordingly, the author clearly ignores the fact that no one going on to WebMD can order a prescription. In fact, majority of the services on WebMD and similar websites are overwhelmingly informational. While the author believes that some kind of brainwash occurs when ads pop up, this claim is farfetched and lacks any evidence to substantiate. As a WebMD spokesman noted last year during the investigation, WebMD has an internal process that “ensures their editorial independence in their programs.” Moreover, the spokesperson recognized that patients going onto WebMD are looking for answers, just like any patient going to a doctor, and that “seeing one ad or taking a test does not suggest this is the only treatment a patient will consider.”

WebMD’s Policies

Specifically, WebMD’s policy on advertising clearly states that “WebMD has sole discretion for determining the types of advertising that will be accepted and displayed on the WebMD Network, and under no circumstances will WebMD's acceptance of any advertisement be considered an endorsement of the product(s) and/or service(s) advertised or for the company that manufactures, distributes, or promotes the products or services.” Moreover, the policy explicitly states that:

WebMD will not accept Advertising that, in WebMD's opinion, is not factually accurate and in good taste; and

WebMD will not permit advertising for illegal or objectionable products, or fraudulent, deceptive, illicit, misleading or offensive material

In addition, “WebMD recognizes and maintains a distinct separation between advertising and sponsored content and editorial content. All Advertising, promotional, sponsored or marketing content on the WebMD Network is clearly and unambiguously identified, and WebMD will not allow any Advertising on the WebMD Network that is not identified with the label of "Advertisement.”

WebMD also retains the exclusive right to “determine how any and all search results for specific information by keyword or topic are displayed on any WebMD Site, and WebMD search results are not influenced based on monetary incentives provided by Advertisers or Sponsors.”

What the author fails to realize is that without the funding from WebMD’s supporters, who are also regulated strictly by WebMD’s policies, the site would not be able to offer free information to the public.

Discussion

Nevertheless, without evaluating WebMD’s policies, which ensure objectivity and freedom from bias, or the benefits of such sites, the author recommends that people “actually block WebMD.” Besides attacking free speech and commercially protected speech that WebMD and other sites provide to Americans, the article makes baseless attacks that WebMD “preys on the fear and vulnerability of its users to sell them half-truths and, eventually, pills.”

But where is the evidence? Did the author conduct any survey of WebMD users (not that this would even closely substantiate her claims)? Where is the proof that sites such as WebMD are harming patients? There is none. Instead, the author relies on her own personal and biased observations of WebMD to claim that the site “frames health information commercially, using the meretricious voice of a pharmaceutical rep.” However, the way the author made this finding is completely flawed, and unscientific: She assumed everything on WebMD was biased and influenced by industry and did not objectively evaluate the site. No wonder she got a “headache.”

Consequently, the author compares WebMD to the Mayo Clinic Health Information site, and tells readers that Mayo gives “good medicine and good ideas.” To distinguish Mayo from WebMD, the author claims its superiority by Mayo’s “storied past as the country’s premier research hospital, in Rochester, Minn., and its storied present as one of Fortune’s 100 Best Companies to Work For.” The author further claims that Mayo’s site is superior because it is “spare and neatly organized, with the measured, learned voice of the best doctors,” even though she acknowledges the site is “not ad-free.”

In the article’s opinion, Mayo is a better because “The integrity of the whole institution is on the line with this site, and the Mayo Clinic has every motivation to keep its information authoritative and up to date. Why would WebMD be any different? Does she think WebMD has more money to throw out and risk their name against public opinion?

Perhaps the most absurd of the authors attacks on WebMD is the description she uses of her search for “headache” on the internet. The author cynically points to the imagery and organization of WebMD’s page in searching for information about headaches. She apparently believes that WebMD should offer the same information as Google or Wikipedia because she complains that her search revealed information about symptoms and other factors associated with headaches. If you were concerned about a headache, and wanted real advice (not a Google search), wouldn’t you want to know about all the possibilities associated with your pain and the possible solutions or remedies?

Conclusion

In the end, if you do not like the health information you are receiving online, then click somewhere else. Don’t suggest that truthful information provided by trained medical professionals is unethical and should be avoided, especially when clear policies are in place to regulate both the information and advertising, and to keep them explicitly separate. Americans are clearly aware of the advertising and companies who buy space all over the internet, and many of them find these ads useful.

WebMD is a valuable resource to millions of patients, and providing information about common drugs and illnesses, and ways to treat them are an important way in improving health. No one on the website can prescribe a patient medicine or force someone into thinking they should take it. The only hysteria or headache caused by WebMD is dealing with critics of this website who are too preoccupied with their own sensational messages. What is the worst that can happen from going on WebMD, a person sees their doctor? When 1 in 3 Americans are obese and likely have numerous health problems, we should be making everyone go on WebMD if it will convince them to see a doctor.

So ask yourself, at a time when Americans are increasingly obese, the rate of diabetes is climbing, and numerous other chronic conditions are going untreated, do we really want to be discouraging Americans from health information? The author’s time would be better spent attacking the millions of commercials about fast food and restaurants that have caused the obesity epidemic and associated health problems. Maybe that will help her headache.

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I think there are some valid points here. But this: "No wonder she got a 'headache.'" is certainly not one of them.

WebMD's Migraines & Headaches Health Center is a bit of a busy page. Rapidly changing images ("Popular Sideshows and Tools on WebMD") can be very annoying when suffering from migraine (as can the last sentence: "Maybe that will help her headache.")

In any case, a more solid comparison would be of interests. It should include, for instance, also MedlinePlus. Is the service of the U.S. National Library of Medicine from the National Institutes of Health really better? If so, then I would at least know where to click next time.